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To identify whether stabilization of larger bladder stones would improve the efficacy of combination (ultrasonic/pneumatic) lithotripsy in a phantom bladder stone model for percutaneous cystolithopaxy.
Using 1cm phantom Bego stones, a spherical model bladder was used to simulate percutaneous bladder access. A UroNet (US Endoscopy, USA) was placed a...
Citations
... The preferred channel for treating stag horn stone is still standard-channel PCNL [23]. In the treatment of large stones, negative pressure suction combined with standard-channel puncture and using ultrasound and pneumatic lithotripsy could effectively shorten the operation time, reduce intrarenal perfusion pressure during surgery, increase stone clearance rate, and reduce complications during and after the operation, especially the occurrence of urinary sepsis [24,25]. Nevertheless, surgery with standard channel may increase the risk of bleeding. ...
Background:
Accurate puncture and dilation of the target kidney calices for percutaneous nephrolithotomy (PCNL) can be difficult. This study aimed to investigate the advantages of PCNL using optical puncture (i.e. the puncture is visualized on a screen as seen through the needle) combined with balloon dilation vs. conventional puncture methods.
Methods:
This was a retrospective study of 58 consecutive patients with kidney stones without hydronephrosis and treated at the Minimally Invasive Urology Center of Zhejiang Provincial People's Hospital between 10/2016 and 12/2017. Twenty-one patients underwent optical puncture combined with balloon dilation PCNL. Thirty-seven patients underwent conventional puncture instrument dilation PCNL (controls). Success rate, tubeless rate, blood loss, pain, and complications were compared between the two groups.
Results:
The one-time puncture success rate (95.2% [20/21] vs. 67.6% [25/37], P = 0.02) and the postoperative tubeless rate (81.0% [17/21] vs. 54.1% [20/37], P = 0.04) were higher in the optical puncture group compared with controls. The average postoperative hemoglobin reduction was smaller (1.13 ± 0.63 vs. 1.56 ± 0.59 g/dL, P = 0.01), the postoperative VAS score was lower (1.6 ± 0.9 vs. 2.5 ± 1.2, P = 0.004), the rate of postoperative analgesic use was lower (14.3% [3/21] vs. 40.5% [15/37], P = 0.04), and the postoperative mean hospitalization days was shorter (3.7 ± 0.9 vs. 4.4 ± 0.8, P = 0.005) in the optical puncture group vs. controls. There was no case of urinary sepsis, blood transfusion, perirenal hematoma, pleural injury, and visceral organ damage.
Conclusions:
Optical puncture combined with balloon dilation PCNL could be associated with good therapeutic effect and low frequency of complications for the treatment of kidney stones without hydronephrosis.
... Stone fragmentation may be performed using any lithotripter through the nephroscope. 3 For each lithotripter, stone stabilization and fragmentation are challenges. 3 In developing countries, the availability of various advanced endoscopic instruments is limited and difficult due to financial constraints. ...
... 3 For each lithotripter, stone stabilization and fragmentation are challenges. 3 In developing countries, the availability of various advanced endoscopic instruments is limited and difficult due to financial constraints. In our study, we assessed a novel cystolithotripsy technique that involves using a semirigid ureteroscope introduced through a cystoscope sheath. ...
Objective:
Various endoscopic instruments used in treating renal stones have been used in managing bladder calculi. Our aim is to evaluate the use of transurethral ureteroscopic pneumatic cystolithotripsy for the management of large bladder calculi.
Patient and methods:
In a retrospective study conducted between May 2005 and July 2011, 53 patients with solitary bladder stones were subjected to our technique, transurethral ureteroscopic pneumatic cystolithotripsy. The mean patient age was 54.3 years. The mean stone size was 4.8 cm.
Surgical procedure:
Diagnostic cystoscopy was performed first. A semi-rigid ureteroscope with a pneumatic probe was introduced through the cystoscope sheath, and pneumatic lithotripsy was performed. The cystoscope sheath works as a draining channel, allowing bladder evacuation. The bladder collapses over the stone and subsequently prevents stone migration, which shortens the lithotripsy’s duration. Stone immobilization allows the transmission of full pneumatic power to the stone. The stone fragments were removed via periodic bladder irrigation using an Ellick evacuation-irrigation system, and a 16-Fr Foley catheter was placed at the end of the procedure.
Results:
Our technique was successful in all cases, including stone-free bladders. No surgical complications were detected. The mean operative time was 83 ± 21.0 minutes, which is comparable to that of standard management. The mean duration of lithotripsy and evacuation was 29.7±18.4 minutes. In the post-operative period, patients were followed up for 18 months, with no urethral stricture being reported in any case.
Conclusion:
The transurethral ureteroscopic pneumatic cystolithotripsy procedure is a safe technique for the management of large bladder calculi. It allows the bladder to collapse over the stone, leading to stone immobilization and subsequently decreasing lithotripsy duration. Our procedure is associated with a minimal chance of post-operative urethral injury because all stone fragments are evacuated through the cystoscope sheath, without contact with the urethral urothelium.
